Biceps Transposition for Biological Superior Capsular Reconstruction

Abstract

Reconstruction of the superior capsule is a valuable intervention for some patients in whom massive, irreparable posterosuperior rotator cuff tears are identified. Superior capsular reconstruction techniques most commonly use either tensor fascia lata autograft or dermal allograft. As an alternative to more traditional superior capsular reconstruction, we commonly transpose and incorporate the biceps tendon into the rotator cuff repair construct in such patients instead. This biological superior capsular reconstruction biceps transposition technique ("bio-SCR"), described herein, provides increased structural integrity and supplemental tendon graft using viable cells while potentially serving the role of the superior capsule. As such, transposition of the biceps tendon may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in appropriate cases.

Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes

“…Ten studies did not fulfill the inclusion criteria, leaving 13 studies for inclusion in the review ( Figure 1 ). Nine studies described relevant surgical techniques without clinical outcomes [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], while the remaining four were clinical studies [ 2 , 24 , 25 , 26 ].…”

“…Nine studies described SCR using the LHBT without clinical outcomes and the dates of publication ranged between 2017 and 2020 [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Four studies were conducted in Asia [ 16 , 19 , 21 , 22 ], three in Europe [ 17 , 20 , 23 ], one in North America [ 18 ], and one included authors both from Asia and Europe [ 7 ].…”

“…Nine studies described SCR using the LHBT without clinical outcomes and the dates of publication ranged between 2017 and 2020 [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Four studies were conducted in Asia [ 16 , 19 , 21 , 22 ], three in Europe [ 17 , 20 , 23 ], one in North America [ 18 ], and one included authors both from Asia and Europe [ 7 ]. The indications of the procedure were irreparable [ 7 , 16 , 17 , 18 , 19 , 22 , 23 ] or repairable [ 20 , 21 ] RC tears, and most authors reported fatty infiltration up to Goutallier/Fuchs grade 4 [ 7 , 23 , 25 , 26 ].…”

“…Four studies were conducted in Asia [ 16 , 19 , 21 , 22 ], three in Europe [ 17 , 20 , 23 ], one in North America [ 18 ], and one included authors both from Asia and Europe [ 7 ]. The indications of the procedure were irreparable [ 7 , 16 , 17 , 18 , 19 , 22 , 23 ] or repairable [ 20 , 21 ] RC tears, and most authors reported fatty infiltration up to Goutallier/Fuchs grade 4 [ 7 , 23 , 25 , 26 ]. Several authors reported an intact or repairable subscapularis tendon as an indication [ 7 , 17 , 21 , 23 ].…”

“…Several authors reported an intact or repairable subscapularis tendon as an indication [ 7 , 17 , 21 , 23 ]. Contraindications were osteoarthritis of the glenohumeral joint, shoulder stiffness, deltoid muscle atrophy or axillary nerve injury, and lesions of the LHBT, i.e., severe tendinitis, partial tear >20% of its substance, and superior labrum anterior to posterior (SLAP) lesion III-IV [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”